Ketamine Reveals Big Pharma’s Treatment of Mental Health Issues

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South Africa faces a myriad of crises. One of them is depression. Recent statistics indicate that 23 South Africans suicide every day and for every person who commits suicide, 10 have attempted it. It’s disturbing on all levels. Even Big Pharma’s vast catalog of supposed “cures” has obviously been very short. This brings us to Ketamine – a very misunderstood drug, mainly due to its origin as a tranquilizer for horses. Ketamine is currently gaining traction as an effective treatment for resistant depression, PTSD, chronic pain, and anxiety. BizNews spoke to a mental health practitioner Doctor Lené le Roux to learn about a therapy that brings hope to many.

Dr Lené le Roux on his journey and his interest in psychiatry

So I trained as a medical doctor at the University of Stellenbosch, graduated in 2013, then did two years of internship at Tygerberg Hospital, followed by a year of community service where I I was lucky enough to be placed in a psychiatric hospital. So even my community service here was only done in psychiatry. And then I did three years of training as a psychiatric registrar at UCT after that. And then I started my own practice. And I’ve been in private practice for about a year and a half.

When I applied for medicine initially, it was right after school. Actually, I applied for psychology and medicine. So I think that’s always been part of what I loved to do. And then when I did my rotations as a psychiatry student, you rotate multiple times in different kinds of disciplines. And every time I did a psych block, I just found that I was the happiest. And so I was very lucky to be able to do my community service in psychiatry and kind of prepare for exams and that sort of thing at the time. Yeah. So I think it’s just a path that I’ve always needed to follow.

On the reputation of ketamine as an ill-advised recreational drug and tranquilizer for horses

Ketamine is initially an anesthetic drug. Yes, people call it a horse tranquilizer, but we also use it in human anesthetics. So, for example, if a child were to break a bone and just needed to be put in the ER, instead of going under full general anesthesia, well, give the child ketamine and reset the bone that way. So it’s been used for many, many years as an anesthetic drug, and we don’t use it in those kinds of doses. When we treat depression, we use much, much lower doses. but its original use was as an anesthetic.

On the process of deciding to try something new in terms of ketamine

I think that’s something that’s become more and more accepted within the psychiatric fraternity over the last few years, because there’s more research that’s been published on this, and we actually have now more treatment guidelines and that kind of stuff that’s evidence-based. And I think all of us, as practitioners working in mental health, become very concerned about our patients. When we’ve tried several different drugs, we’ve tried different classes of drugs, we’ve tried augmenting them with things like antipsychotics, and we’ve hit a wall where some patients just don’t respond.

But now that we have access to ketamine, it’s a great extra tool in our toolbox that we can use when we hit that wall. And it doesn’t have to be a patient who has been suffering from depression for years. This may be someone who has more acute depression but is not responding adequately to medication or who is at very high risk of suicide. So, people sometimes refer to ketamine as the anti-suicide drug because it changes the suicidal tendency very quickly. So we sometimes use it in that sense as an emergency measure, but we also use it in patients who have long-standing chronic depression.

About the treatment process and its timing and whether it can be abused

The first antidepressant effects of ketamine are seen within 24 hours of your first injection. We do the initial treatment of six sessions, and then it’s very patient-focused. So if they haven’t completely gone into remission within those six sessions, we recommend a few refills, usually 2-3. Children’s immune response is very different. So sometimes after a few months we might have to do two or three sessions again just to get them back on track.

I think it’s not something that will ever be administered at home because there is potential for abuse. Esketamine is a form of ketamine that will be launched later this year in South Africa, and it is a nasal spray. But it will also need to be done under the full supervision and guidance of a doctor. OK. So there is potential for abuse with ketamine because it is, as you know, used as a recreational drug. However, we don’t really see this in clinical practice when administering under supervision.

It is a pleasurable experience most of the time for patients to start seeking that pleasure. It is not something that is addictive, in the sense that you have withdrawal symptoms or you develop a tolerance, which is a bit different from other drugs. One of the indications for ketamine is substance use disorders. People with alcoholism, cocaine addiction, that sort of thing found that they had reduced cravings if they had a few sessions of ketamine. So it’s actually used to help patients quit other recreational drugs.

On finding other alternative forms of treatment

Psilocybin, which is a mushroom, is currently the subject of extensive research internationally as its use in depression has been approved in other countries and protocols are still being developed to administer it. And it is often used as part of a psychotherapeutic intervention. So patients will actually have therapy sessions to prepare them for psilocybin dosing.

They will then have psilocybin under the care of a therapist and have a few more sessions, have another session of psilocybin. A protocol is being developed and they have amazing results. I think that’s something that’s going to be available in the future here as well. Once this research is somehow finalized and the evidence is there, hopefully it will be available to the South African public as well.

On the legal challenges of decriminalizing the substance for therapeutic purposes

It is not criminalized at the moment. It is legal. This is an off-label use. So ketamine is a legal drug for doctors to use but it’s an off label use for school of depression and esketamine is hopefully going to be used off label and it’s been approved In other countries. So that’s something that medical aids might even end up paying for: at the moment, they don’t pay for ketamine treatment for depression at all.

But once it hits the label, they’ll probably start funding it as well, which will be great because Esketamine nasal spray is extremely expensive. It’s around R3,000 per spray and for one session you sometimes need up to three sprays. So it’s a 9,000 rand decision. So yes, it will not be something accessible if the medical aids do not pay for it.

On the range of disorders that ketamine can help

At the moment we mainly use it for treatment-resistant depression, and that is for people with major depression as well as bipolar depression. There has actually been the most research done on bipolar patients with depression where there is a risk when you start an antidepressant. With bipolar patients, if you start an antidepressant, they can go manic and kind of switch to the opposite spectrum. Ketamine does not cause this mania, so it is a safe way to intervene for bipolar depression.

Then all anxiety disorders, social anxiety disorder has very good results and generalized anxiety disorder, OCD. So these are the anxiety disorders that we are targeting. And then PTSD is another where this very good research for PTSD treatment with ketamine. Chronic pain is something that’s also used, but it’s a bit controversial among doctors whether it’s something we should use or not. But it makes the brain more sensitive to opioids. So, it actually helps the pain medications that patients take to work more effectively.

Whether ketamine can be used in conjunction with psychotherapy and psychological counseling

I mean, assisted psychotherapy isn’t really available right now. There is a clinic that offers it, but it’s very expensive because it’s quite time consuming. And obviously, you need a psychotherapist present. The way I do my sessions is that I sit down with the patient ahead of time and think about what we are doing today. So that’s an intention for the session: whether it’s just having compassion for themselves, focusing on healing, what’s going to happen in their brain, and if that comes up for them and on their intention, we focus on, then after we spend 10 minutes debriefing the session. What did they see? What have they been through? Did anything specific stand out? I want them to leave feeling like they’ve had time to process the session.

And so, of course, I’m not a psychotherapist by training and it’s not my specialty, but I offer a kind of psychological support in this sense at each session. And the patients also have their own psychotherapists, so they continue to see the psychotherapists privately while they are doing the ketamine treatment. Once or twice a week they also see their therapist. And I’m usually in contact with the therapist during this time.

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